Working With Clients With Disabilities: The Case Of Lesterle

Working With Clients With Disabilities The Case Of Lesterlester Is A

Working With Clients With Disabilities: The Case of Lester Lester is a 59-year-old, African American widower with two adult children. He lives in a medium-sized Midwestern city. Four months ago, he was a driver in a multiple vehicle crash while visiting his daughter in another city and was injured in the accident, although he was not at fault. Prior to the accident he was an electrician and lived on his own in a single-family home. He was an active member in his church and a worship leader.

He has a supportive brother and sister-in-law who also live nearby. Both of his children have left the family home, and his son is married and lives in a nearby large metropolitan area. When he was admitted to the hospital, Lester’s CT showed some intracerebral hemorrhaging, and the follow-up scans showed a decrease in bleeding but some midline shift. He seemed to have only limited cognition of his hospitalization. When his children came to visit, he smiled and verbalized in short words but could not communicate in sentences; he winced and moaned to indicate when he was in pain.

He had problems with balance and could not stand independently nor walk without assistance. Past medical history includes type 2 diabetes; elevated blood pressure; a long history of smoking, with some emphysema; and a 30-day in-house treatment for binge alcoholism 6 years ago following his wife’s long illness with breast cancer and her subsequent death. One month ago he was discharged from the hospital to a rehabilitation facility, and at his last medical review it was estimated he will need an additional 2 months’ minimum treatment and follow-up therapies in the facility.

As the social worker at the rehab center, I conducted a psychosocial assessment after his admission to rehabilitation. At the time of the assessment, Lester was impulsive and was screened for self-harm, which was deemed low risk. He did not have insight into the extent of his injury or changes resulting from the accident but was frustrated and cried when he could not manipulate his hands. Lester’s children jointly hold power of attorney (POA), but had not expressed any interest to date in his status or care. His brother is his shared decision-making (SDM) proxy, but his sister-in-law seemed to be the most actively involved in planning for his follow-up care. His son and daughter called but had not visited, but his sister-in-law had visited him almost daily; praying with him at the bedside; and managing his household financials, mail, and house security during this period. His brother kept asking when Lester would be back to “normal” and able to manage on his own and was eager to take him out of the rehabilitation center.

Lester seemed depressed, showed some flat affect, did not exhibit competency or show interest in decision making, and needed ongoing help from his POA and SDM. His medical prognosis for full recovery remains limited, with his Glasgow Coma Scale at less than 9, which means his injury is categorized as catastrophic. Lester currently has limited mobility and is continent, but he is not yet able to self-feed and cannot self-care for cleanliness; he currently needs assistance washing, shaving, cleaning his teeth, and dressing. He continues with daily occupational therapy (OT) and physical therapy (PT) sessions. He will also need legal assistance to apply for his professional association pension and benefits and possible long-term disability.

He will also need help identifying services for OT and PT after discharge. He will need assistance from family members as the determination is made whether he can return to his residence with support or seek housing in a long-term care facility. He will need long-term community care on discharge to help with basic chores of dressing and feeding and self-care if he is not in a residential care setting. A family conference is indicated to review Lester’s current status and short-term goals and to make plans for discharge.

Paper For Above instruction

The case of Lester exemplifies the complexities and multidimensional challenges faced when working with clients with disabilities, particularly following catastrophic injuries such as traumatic brain injury (TBI). As health professionals, understanding Lester’s medical, psychological, and social context is critical for developing an effective, person-centered plan tailored to his needs, preferences, and circumstances. This paper explores the key considerations and best practices when working with clients with disabilities in similar situations, emphasizing assessment, ethical decision-making, interdisciplinary collaboration, and family involvement.

Understanding the Medical and Functional Status of Clients with Disabilities

Lester’s injuries are severe, with a Glasgow Coma Scale score of less than 9 indicating a catastrophic brain injury. Such injuries often result in profound cognitive, motor, and sensory deficits requiring ongoing multidisciplinary interventions. The medical assessment reveals he has limited mobility, dependence on assistance for self-care, and communication difficulties. Recognizing the extensive physical and cognitive impairments is fundamental in establishing realistic goals and expectations for recovery and long-term care.

His medical history, including diabetes, hypertension, emphysema, and alcoholism, complicates his recovery trajectory and necessitates a comprehensive management plan addressing both primary and secondary health issues. These comorbidities increase the risk for complications such as infections, pressure ulcers, and worsening functional status, which must be carefully monitored and addressed.

Psychosocial and Emotional Aspects of Disability

Lester exhibits signs of depression, flat affect, and frustration, common among individuals facing sudden and severe disabilities. These emotional responses can impede engagement in rehabilitation and affect overall well-being. Mental health support, including counseling and psychotherapy, should be integrated into his care plan to address grief, loss, and adjustment challenges. Recognizing his limited insight into his injuries underscores the importance of compassionate communication strategies that acknowledge his emotional state while providing education about his condition.

Additionally, Lester’s impulsivity and low self-awareness highlight the need for tailored behavioral interventions and safety planning to prevent self-harm or other adverse events during recovery. Supportive interventions should also include activities that promote emotional expression and social engagement, crucial for mental health and motivation.

Family and Decision-Making Processes

Lester’s family dynamics significantly influence his care. His children hold POA but have shown limited involvement, while his sister-in-law actively manages his daily needs and participates in care planning. His brother serves as the SDM proxy but is eager to see him recover and regain independence. This divergence highlights the importance of clear communication, respecting ongoing family roles, and ensuring that decision-making aligns with Lester’s values and preferences.

In case of limited capacity, as in Lester’s situation, ethical considerations around autonomy and beneficence are paramount. Health professionals must ensure that Lester’s rights are upheld while providing necessary protections. Family conferences serve as critical platforms for transparent discussions, goal setting, and consensus-building among providers and family members about the most appropriate care pathway.

Ethical and Legal Considerations

The legal aspects of capacity, POA, and SDM are central to Lester’s case. His joint POA indicates shared decision-making, but the apparent lack of interest from his children and active involvement of other family members complicates this process. Healthcare teams must navigate these legal arrangements, ensuring decisions are made in Lester’s best interests, respecting his dignity and rights.

Moreover, ethical principles such as autonomy, beneficence, non-maleficence, and justice inform all decisions related to his treatment and discharge planning. Respecting Lester’s preferences, even when communication is limited, involves using advance directives if available, and involving surrogate decision-makers appropriately.

Transitioning to Discharge and Long-Term Care Planning

Discharge planning is a critical phase requiring a coordinated approach among multidisciplinary teams, family, and Lester. Given his current functional impairments, options include returning home with community support or placement in a long-term care facility. Each option presents benefits and challenges, such as ensuring adequate home modifications, caregiver support, and access to outpatient therapies.

A comprehensive needs assessment assessing Lester’s functional abilities, environmental safety, caregiver capacity, and available resources must guide this decision. Community resources, including home health services, occupational therapy, and assistive devices, play vital roles in supporting his independence. When community options are insufficient, residential care facilities specialized in brain injury rehabilitation may be considered.

Importance of a Family Conference and Collaborative Care Approach

A family conference allows transparent discussion of Lester’s prognosis, realistic goals, and preferences, fostering shared decision-making. It also provides an opportunity to educate family members about his condition, expected outcomes, and the importance of continued support.

Interdisciplinary collaboration among neurologists, rehabilitation specialists, social workers, mental health professionals, and legal advisors ensures comprehensive care addressing medical, emotional, social, and legal needs. Such teamwork promotes holistic recovery, enhances communication, and supports Lester and his family throughout his rehabilitation journey.

Conclusion

Working effectively with clients like Lester requires a blend of clinical expertise, compassionate communication, respect for legal and ethical principles, and family-centered approaches. Tailoring interventions to his complex medical and psychosocial needs can optimize his quality of life and functional outcomes. As healthcare providers, continuous assessment, cultural sensitivity, and collaboration are paramount in navigating the challenges posed by severe disabilities and ensuring that care aligns with the client’s dignity and preferences.

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